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INTEROFFICE MEMORANDUM Maricopa County Education Service Agency (aka Maricopa County Superintendent of Schools Office) TO: CLERK OF THE BOARD FROM: Terri Ysaguirre SUBJECT: Affidavits — Replacement of Lost Warrants DATE: 10/24/2018 Please find attached 1 Affidavit/Notice of Claim(s) for lost warrants for inclusion on the next available Board agenda V The attached item(s) have been researched to ensure that the warrant(s) in question have not been cashed or previously re-issued. V The original warrant(s) have had a stop payment done. If you have any questions, please contact Terri Ysaguirre at 602-372-1245 or via e-mail at terri.ysaguirre@mcesa.maricopa.gov . Approved Affidavits may be routed back to the Superintendent of School Finance Division at 4041 N. Central Avenue #1200, (12th Floor) Thank you. #75 Agua Fria Union Student Television Network $75.00 RECEIVED OCT 2 5 2018 MARICOPA COUNTY CLERK BOARD OF SUPERVISORS ▪ Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: k'J Duplicate or El Stale-Dated (definitions are on page 2) STATE OF ARIZONA I Note: Numbers on this form correspond to numbers on the COUNTY OF MARICOPA Instruction sheet which is page 2 of this form. 104/11. op_ SIVIVINT -rot,54,11.1o,A1 - No-rwor 49A (1), bei ng first sworn, upon oath deposes and says: aim n On or about I/N(16x/ 2) 1 D 1 (date)(2) a warrant/check was issued to the above named person/entity in the amount as stated below. Such warrant/check was either never received or was subsequently inadvertently lost or destroyed and there is no reasonable probability of its being found or presented for payment, or it was not presented for payment within one year after the date of issuance. Therefore, under penalty of perjury, claimant hereby affirms that this claim is correct and the amount shown is due and owing, and the applicant requests that a replacement warrant/check be issued to him/her in the sum of $ GO • _.(3) Signed: /Lk__ 4 (4) Note; Pleas' attach a copy of the warrant/check : if available and/or any other evidence that a warrant/check was originally issued. (5) Subscribed and sworn to before me this day of 20 NOTARY PUBLIC OFFICIAL SEAL ABE ALBANNA NOTARY PUBLIC-CALIFORNIA My commission expires: SAN COMM. DIEGO NO. COUNTY 2107006 Vv (4-1 ti/ 20 l c) MY COMM. EXP. NAN. 2019 -37 r__)cii) ,t_v-0s) Original Date of Issue (if known) (7) Reason for original issue of Warrant/Check (8): O Payroll CLERK - O For Services or Goods furnished O Treasurer's refund/payment Other: 1 at, b,u2_,L. S:\PROCESSES\Warrants - Duplicate or Stale\02 Forms\Warrants Checks notice of claim - Copy.doc Revised April 2015 A.R.S. 11-632 & 11-644